OP0251 IMPACT OF INTERSTITIAL LUNG DISEASE ON SEVERE COVID-19 OUTCOMES FOR PATIENTS WITH RHEUMATOID ARTHRITIS: A MULTICENTER STUDY
Authors: E. Gilbert, G. Figueroa-Parra, M. Valenzuela-Almada, S. Vallejo, M. R. Neville, N. Patel, C. Cook, X. Fu, R. Hagi, G. McDermott, M. Di Iorio, L. Masto, K. Vanni, E. Kowalski, G. Qian, Z. Wallace, A. Duarte-Garcia, J. Sparks
Journal: Annals of the Rheumatic Diseases (2022)

Background RA has been associated with poor COVID-19 outcomes, but few studies have investigated outcomes in RA features such as interstitial lung disease. Objectives To assess COVID-19 outcomes in patients with RA overall, and those with and without ILD, compared to general population comparators. Methods A multicenter, retrospective cohort study was conducted at Mayo Clinic (19 hospitals and affiliated outpatient centers in 4 states) and Mass General Brigham (14 hospitals and affiliated outpatient centers in New England). Consecutive patients with RA meeting ACR/EULAR criteria and a positive COVID-19 test from March 1, 2020 through June 6, 2021 were matched 1:5 on age, sex, race, and COVID-19 test date with general population comparators without RA. RA features assessed included: RA-ILD per Bongartz criteria [1], duration, rheumatoid factor (RF), cyclic citrullinated peptide antibody (CCP), bone erosions, and treatments. The primary outcome was a composite of hospitalization or death following COVID-19 diagnosis. We used multivariable Cox regression to investigate the association of RA, and features such as ILD, with COVID-19 outcomes compared to matched comparators. Results We analyzed 582 patients with RA and 2892 comparators without RA, all with COVID-19. Mean age was 62 years, 51% were female, and 79% were White. Mean RA duration was 11 years, 67% were seropositive (52% RF+ and 54% CCP+), 27% had bone erosions, 28% were on steroids, and 79% were on DMARDs. 50/582 (9%) patients with RA had ILD. The COVID-19 hospitalization or death rate for RA patients was higher than comparators (3.0 per 1,000 days [95% CI 2.5-3.6] vs. 1.9 per 1,000 days [95% CI 1.7-2.1], respectively). Overall, RA patients had a 53% higher risk of hospitalization or death than comparators after adjustment (95% CI 1.20-1.94). Among those with RA-ILD, the hospitalization or death rate was significantly higher than comparators (10.9 [95% CI 6.7-15.2] vs. 2.5 per 1,000 days [1.8-3.2], respectively). RA-ILD was associated with nearly 3-fold higher risk for hospitalization or death than comparators (multivariable HR 2.84 [95% CI 1.64-4.91], Table 1). There was a significant interaction between RA/comparator status and presence/absence of ILD for risk of severe COVID-19 (p&lt;0.001, Figure 1). The elevated risk for severe COVID-19 was similar for RA subgroups defined by serostatus or bone erosions. Table 1. Frequencies, proportions, and hazard ratios for COVID-19 outcomes, comparing all RA patients, and subgroups with or without RA-ILD, to matched comparators. COVID-19 Outcomes All RA Patients (n=582 ) RA-ILD (n=50 ) RA Patients without ILD (n=532 ) Comparators (n=2,892 ) Hospitalization , n (%) 121 (21) 24 (48) 97 (18) 402 (14) Unadjusted HR (95% CI) 1.58 (1.27, 1.96) 2.65 (1.71, 4.09) 1.43 (1.12, 1.82) Ref. Adjusted* HR (95% CI) 1.45 (1.14, 1.83) 2.35 (1.38, 4.00) 1.31 (1.00, 1.70) Ref. Death , n (%) 26 (4) 9 (18) 17 (3) 63 (2) Unadjusted HR (95% CI) 1.72 (0.98, 3.01) 5.88 (2.07, 16.71) 1.13 (0.56, 2.29) Ref. Adjusted* HR (95% CI) 1.24 (0.66, 2.32) 13.94 (4.30, 45.18) 0.75 (0.35, 1.63) Ref. Hospitalization or death , n (%) 126 (22) 25 (50) 101 (19) 419 (14) Unadjusted HR (95% CI) 1.66 (1.33, 2.07) 3.01 (1.93, 4.70) 1.47 (1.14, 1.89) Ref. Adjusted* HR (95% CI) 1.53 (1.20, 1.94) 2.84 (1.64, 4.91) 1.34 (1.02, 1.77) Ref. *Adjusted for age, sex, race, and smoking Figure 1. Multivariable hazard ratios for the composite outcome of hospitalization or death from COVID-19, comparing all RA and subgroups by serostatus, bone erosions, and ILD to matched comparators without RA. Conclusion We confirmed that RA was associated with severe COVID-19 outcomes compared to the general population. We found evidence that ILD may be an effect modifier for the relationship between RA and severe COVID-19 outcomes, but RA subgroups defined by serostatus and bone erosions had similarly elevated risk. These findings suggest that ILD or its treatment may be a major contributor to severe COVID-19 outcomes in RA. References [1]Bongartz, T, et al, Arthritis Rheum. 2010 Jun;62(6):1583-91. Disclosure of Interests None declared